基层医院急性结石性胆囊炎行腹腔镜胆囊切除术的体会

Experience of laparoscopic cholecystectomy for acute stony cholecystitis in basic hospital

目的:探讨基层医院急性结石性胆囊炎行腹腔镜胆囊切除术(LC)的安全性和可行性。方法:对43例行LC治疗的急性结石性胆囊炎患者临床资料进行回顾性分析。结果:43例患者中41例顺利完成LC,成功率95.34%。手术时间20～86 min,平均(43±8)min,术中出血量10～160 mL,平均(30±5)mL,住院时间3～16 d,平均(6.98±1.36)d。所有患者均在文氏孔置管引流,于术后1～3 d(引流量在10 mL/d以下)拔除。中转开腹2例;术中出血3例,均在腹腔镜下止血成功。所有患者均未发生胆道损伤、胆漏、术后出血及腹腔残余感染等手术相关并发症。结论:在术者熟悉胆囊三角解剖并具有丰富的腹腔镜手术经验以及娴熟的LC操作技巧的基础上,在基层医院对急性结石性胆囊炎患者行LC治疗安全有效,值得推广。

Objective:To investigate the safety and feasibility of laparoscopic cholecystectoncy(LC) in primary hospitals in acute calculous cholecystitis. Methods: The clinical data of 43 patients with acute calculous cholecystitis who had LC in Hospital. Results: Of the 43 patients, 41 patients successfully finished LC with a success rate of 95.34%. The operation time was between 20 to 86 min, with an average of(43±8)min. The intraoperative blood loss was 10~160 mL, with an average of(30±5)mL. The hospital stay was 3~16 d, with an average of(6.98±1.36)d. All patients operated drainage in the Venturi hole and were removed 1 to 3 days after surgery(with a drainage volume below 10 mL/d).Three cases of intraoperative hemorrhage were successful in laparoscopic hemostasis. All patients had no operative complications such as biliary injury, bile leakage,postoperative bleeding and residual abdominal infection. Conclusion: On the basis of the surgeon’s familiarity with the anatomy of the gallbladder and rich experience in laparoscopic surgery and skilled LC operation skills, LC is safe and effective for patients with acute calculous cholecystitis. It is worthy of promotion.